Having your disability claim DENIED is frustrating! But, you need to get started on your appeal as soon as possible. Generally speaking, in Louisiana, there are three major steps in appeal a denial for social security benefits (many other states have four).
First Step: ALJ Hearing
The first step after an initial denial for most Louisiana social security disability claims is to file a Request for Hearing with an ALJ (Administrative Law Judge). This is generally the most important step of the entire Social Security disability benefits appeal process because it is where you have the best chance at winning your claim.
You can request a hearing by filling out a request form online or sending a written request to your local Social Security office. Your request for an ALJ hearing must be made either online at the SSA.gov website or in writing.
You are eligible to request an ALJ hearing if you have received a Notice of Denial from the Social Security Administration (SSA). The request process requires you to update your personal information and provide additional information about your disability in order to be considered for benefits during the appeals process.
IMPORTANT – your request for a hearing must be made within 60 days of a Notice of Denial unless you have good cause for not appealing within the 60 days.
At the hearing, you will present all of your medical evidence to establish that you have a severe medical condition that limits your ability to work and prevents you from completing your past work and any other work. Depending on the specific facts of your case, a vocational expert and a medical expert may be present or testify along with the ALJ, a hearing reporter, and you.
Second Step: Appeals Council
Even though an ALJ hearing offers the best chance of success for obtaining your disability benefits, you may still be denied by the ALJ. If the ALJ denies your claim, the next appeal is to the Social Security Administration’s Appeals Council. You request Appeals Council review by filing a Request for Review of a Hearing Decision.
IMPORTANT – This appeal must be filed within 60 days of receiving the denial notice from the ALJ hearing unless you have good cause for not appealing within the 60 days..
The Appeals Council generally reviews the ALJ decision to determine whether the judge made a mistake or error of law or fact in the decision. You may submit new and material evidence to the Appeals Council if it is available.
The Appeals Council can deny an appeal completely (ALJ’s decision stands), reverse the ALJ decision and grant benefits, or send the case back to an ALJ with specific instructions for another hearing.
When your claim gets to the Appeals Council, there is usually no appearance or testimony taken by the Appeals Council. They simply review the evidence contained in your file along with the ALJ’s decision and make a determination.
Third Step: Federal District Court
If your claim has been denied by the ALJ and Appeals Council, the next option is to appeal the decision with the federal district court. An appeal must be filed within 60 days of receiving a denial from the Appeals Council unless you have good cause for not appealing within the 60 days..
A civil complaint must be filed in order for an applicant to appeal the decision of the Appeals Council. This complaint should be filed with the Federal District Court with jurisdiction for the area your reside.
You will act as the plaintiff during the case. The defendant is the Commissioner of the SSA, who is represented by the United States’ Attorney for your district. SSA does not assist applicants with filing a civil complaint. A good idea is to contact an attorney who is experienced in federal court petitions to assist with this process. If you do not follow federal court rules properly, your case may be dismissed.
The judge in a federal district court case has three options: (1) affirm the decision of the SSA (denial stands); (2) reverse decision of SSA and grant benefits; or (3) remand case back to the ALJ or Appeals Council with specific instructions.
Many states have another step called Reconsideration. Reconsideration comes before an ALJ hearing in about 40 states. Reconsideration is really just another administrative review of the decision to deny benefits. During this step, new evidence can be submitted but there is no hearing. If your claim is denied during reconsideration, you would file for an ALJ hearing.